http://www.sciencedirect.com/science/article/pii/S1052305712003801
Background
Warfarin-associated
intracerebral hemorrhage (WAICH) is expected to increase in prevalence
as the population ages. We sought to evaluate national trends,
characteristics, and in-hospital outcomes among intracerebral hemorrhage
(ICH) patients taking warfarin at baseline.
Methods
We reviewed the Nationwide Inpatient Sample to identify all admissions with primary diagnosis of ICH by International Classification of Diseases, Ninth Revision
code (431) from 2005 to 2008. We identified premorbid warfarin use by
the V code (V58.93) and calculated the proportion of WAICH among all ICH
patients in each year. We employed univariate statistics and
generalized estimating equation regression models to assess whether
warfarin use independently increased the risk of in-hospital mortality
after adjusting for relevant covariates. P value less than .05 was considered significant.
Results
There
were 52,993 patients (mean age 68.8 years; 49.7% male) coded for ICH
between 2005 and 2008. The proportion with WAICH increased each year
(2005, 5.8%; 2006, 6.5%; 2007, 6.9%; 2008, 7.3%; P < .001). While in-hospital mortality declined each year for non-WAICH (29.0%-25.4%, P < .001), it remained unchanged for WAICH (42.1%-40.0%, P = .346).
In multivariable analysis, warfarin use (adjusted odds ratio 1.35; 95%
confidence interval 1.24-1.47) remained an independent predictor of
in-hospital mortality.
Conclusions
WAICH
is increasing in prevalence in the United States and is associated with
a 35% higher mortality than non-WAICH. While mortality has declined
over time for non-WAICH, mortality after WAICH is unchanged. Specific
strategies to decrease the mortality of WAICH such as rapid reversal of
anticoagulation are warranted.
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